Acute seizure management in a private hospital

Abstract

Objectives To examine the management of first-ever seizures and untreated recurrent seizures presenting to a major comprehensive private hospital in Melbourne. Methods We reviewed medical records of patients with discharge ICD-10 codes of G40 (epilepsy) or G41 (status epilepticus) discharged between 1 January 2008 and 30 November 2016. Patients were included if they presented with a first ever seizure or untreated recurrent seizures either to the ED or during hospitalisation for other reasons. Patients were excluded if they had previous diagnosis of epilepsy or had non-epileptic event. Results Two-hundred and forty four patients were identified. One-hundred and fifty nine were excluded and 76 were included for analysis. Among those included, 65.8% presented to ED and 34.2% had seizures during hospitalisation. Their median age was 75.5 years (range 14 to 91); 48.7% were male. Seizure classifications included acute symptomatic (19.7%), remote symptomatic (19.7%), association with idiopathic generalised epileptic syndromes (5.3%), and unclassified (55.3%). 80% presenting to ED received CT brain; 54% within 2 hours. 50% underwent MRI and 60.5% EEG, with a median time from admission to test of 2 days and 3 days, respectively. Phenytoin was prescribed as the initial antiepileptic drug (AED) for (46.9%) patients with a first ever seizure. A broader range of initial AEDs were used in those with untreated, recurrent seizures. EEG resulted in identification of IGE syndromes in 4 patients, leading to medication alteration. 84% of patients were reviewed or admitted under a neurologist. Follow-up with neurologist was planned for 60.5% at discharge. Conclusions Timely investigations and neurological review are valuable in the diagnosis and treatment of patients with first seizures or recurrent, untreated seizures. Future studies should focus on identifying factors associated with rapid diagnosis and treatment decision that may ultimately lead to improved seizure control.